Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Diagnosing a shoulder dislocation is usually obvious—the arm is stuck, the pain is severe, and the shoulder looks wrong. However, the real diagnostic work begins after the shoulder is put back in place. The doctor needs to know what damage was done. Did you tear the labrum? Did you break the bone? Did you damage the rotator cuff?
This section explains the diagnostic journey. We will cover the physical exam (both before and after reduction), the essential role of X-rays, and why MRI is the gold standard for seeing the soft tissue damage that predicts future problems. We will also discuss nerve testing, which is a crucial safety check often performed in the emergency room.
In the emergency setting, the exam is brief but focused. The doctor checks the shape of the shoulder. An anterior dislocation causes a “squared-off” look because the deltoid muscle is stretched flat.
Critically, they check the nerves. The axillary nerve wraps right around the neck of the humerus. A dislocation can stretch this nerve, causing numbness on the outside of the shoulder (the “regimental badge” area) and weakness in lifting the arm. They also check the pulse at the wrist to ensure the axillary artery hasn’t been kinked or torn. These checks are repeated after the shoulder is reduced to ensure function has returned.
X-rays are mandatory. Before reduction, they confirm the direction of the dislocation (front or back) and check for fractures. Trying to pull on a shoulder that has a broken neck of the humerus can be disastrous, potentially separating the head from the shaft.
After reduction, X-rays confirm the joint is seated correctly. They also reveal bony injuries like the Hill-Sachs lesion (dent in the ball) or a Bony Bankart (chip off the socket rim). Special views, like the axillary view or Stryker notch view, are used to see these specific bone defects clearly.
Once the acute pain subsides (usually a week or two later), an MRI is often ordered, especially for young athletes. An MRI shows the soft tissues: the labrum, the ligaments, and the rotator cuff tendons.
Often, a dye is injected into the shoulder before the scan (MR arthrogram). The dye expands the joint capsule and flows into any tears in the labrum, making them show up brightly on the scan. This type of exam is the most accurate way to diagnose a Bankart lesion (torn labrum) or a SLAP tear. For patients over 40, the MRI is vital to check for rotator cuff tears, which happen in a significant percentage of older dislocations.
If the X-rays or MRI suggest significant bone damage, a CT scan is ordered. A CT scan provides a 3D map of the bones. It allows the surgeon to measure exactly how much bone has been lost from the glenoid socket.
If more than 20–25% of the socket rim is missing, soft tissue surgery (like a Bankart repair) will likely fail. In these cases, the CT scan helps plan for bone-grafting procedures like the Latarjet operation to rebuild the socket.
For patients with chronic instability, the exam in the clinic is more detailed. The doctor performs “provocative tests.” The apprehension test involves placing the arm in the throwing position and gently pushing forward. If the patient feels like the shoulder is going to pop out and resists (apprehension), it is a positive sign of anterior instability.
The relocation test involves pushing the shoulder backward in the same position. If this relieves the apprehension, it confirms the diagnosis. The doctor also checks for generalized looseness (hyperlaxity) by checking if the thumb can touch the forearm or if the elbows hyperextend.
If numbness or weakness persists for weeks after the dislocation, an EMG (electromyogram) and nerve conduction study might be ordered. This tests the electrical function of the nerves.
It helps distinguish between a nerve that is just stunned (neurapraxia), which will recover on its own, and a nerve that is severely damaged (axonotmesis), which might need surgical exploration.
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It involves a needle poke into the shoulder, which can feel like pressure or a pinch. The joint might feel full or tight afterwards, but it is generally well-tolerated.
X-rays only show bone. They do not show the labrum or rotator cuff. You can have a “normal” X-ray but a completely detached labrum that will cause your shoulder to dislocate again. The MRI finds the “silent” damage.
If your shoulder is dislocated, moving is very painful. Radiologists are trained to take pictures with minimal movement. However, getting the necessary angles is important for safety.
This is a complex injury called a fracture-dislocation. It usually requires surgery to repair the bone and stabilize the joint. Simple pulling (closed reduction) is risky and usually avoided or done with extreme caution under anesthesia.
Most nerve injuries from dislocations are stretch injuries that recover spontaneously. Sensation often returns in weeks, while muscle strength can take months. Permanent damage is rare but possible.
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